THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Ames Dental P.C., doing business as Queens Central Dental

Effective date: October 16, 2026

Your Information. Your Rights. Our Responsibilities.

This notice explains how we may use and share your dental and health information, the rights you have over it, and the duties we have to protect it. It applies to all records of your care at Queens Central Dental. If you have questions, call us at (718) 429-0440.

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get a copy of your dental and health records

• You can ask to see or get a paper or electronic copy of your records and other health information we have about you. Ask us how to do this.
• We'll provide a copy or a summary of your information as quickly as New York law and HIPAA require, and no later than 30 days after your request. We may charge a reasonable, cost-based fee that the law allows.

Ask us to correct your records

• You can ask us to correct health information about you that you think is wrong or incomplete. Ask us how to do this.
• We may say "no" to your request, but we'll tell you why in writing within 60 days.

Request confidential communications

• You can ask us to contact you in a specific way (for example, a cell phone instead of a home phone) or to send mail to a different address.
• We will say "yes" to all reasonable requests.

Ask us to limit what we use or share

• You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree, and we may say "no" if it would affect your care.
• If you pay for a service or item out of pocket in full, you can ask us not to share that information with your health insurer for payment or our operations. We will say "yes" unless a law requires us to share it.

Get a list of those we've shared information with

• You can ask for a list (an accounting) of the times we've shared your health information in the six years before the date you ask, who we shared it with, and why.
• The list includes all disclosures except those for treatment, payment, and health care operations, and certain others, such as any you asked us to make. We'll provide one list a year for free, and may charge a reasonable, cost-based fee if you ask for another within 12 months.

Get a copy of this notice

You can ask for a paper copy of this notice at any time, even if you agreed to receive it electronically. We will give you a paper copy promptly.

Choose someone to act for you

If you have given someone medical power of attorney, or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

• You can complain if you feel we have violated your rights by contacting us using the information at the end of this notice.
• You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/complaints.
• We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and the choice to tell us to:

• Share information with your family, close friends, or others involved in your care or in paying for it
• Share information in a disaster relief situation

If you are not able to tell us your preference, for example if you are unconscious, we may share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:

• Marketing purposes
• Sale of your information

Fundraising: We do not use your information for fundraising. If that ever changes, we will give you a clear and conspicuous chance to opt out before we contact you, including before any substance use disorder records are used for fundraising.

Our Uses and Disclosures

How do we typically use or share your health information? We typically use or share your health information in the following ways.

Treat you. We can use your health information and share it with other professionals who are treating you. Example: We send your X-rays to an oral surgeon you're referred to, or send impressions and case details to the dental lab that makes your crown.

Run our practice. We can use and share your health information to run our practice, improve your care, and contact you when necessary. This includes appointment reminders by phone or text and asking about your experience after a visit. Example: We use your information to schedule your next cleaning and send you a text reminder.

Bill for your services. We can use and share your health information to bill and get payment from dental and health plans or other entities. Example: We give information about you to your dental insurance plan so it will pay for your services.

Business associates. We use outside companies for some services, such as practice management software, billing, and IT support. They may see your information only to do that work, and they must protect it under a written agreement with us.

How else can we use or share your health information? We are allowed or required to share your information in other ways, usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information, see HHS's guide to your rights under HIPAA.

• Help with public health and safety issues: preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence, and preventing or reducing a serious threat to anyone's health or safety
• Do research: we can use or share your information for health research, under the conditions the law sets
• Comply with the law: we will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we're complying with federal privacy law
• Respond to organ and tissue donation requests: we can share health information about you with organ procurement organizations
• Work with a medical examiner or funeral director: we can share health information with a coroner, medical examiner, or funeral director when an individual dies, including to help identify a person through dental records
• Address workers' compensation, law enforcement, and other government requests: for workers' compensation claims, for law enforcement purposes or with a law enforcement official, with health oversight agencies for activities authorized by law, and for special government functions such as military, national security, and presidential protective services
• Respond to lawsuits and legal actions: in response to a court or administrative order, or in response to a subpoena

Substance use disorder records. If we receive records from a federally assisted substance use disorder program protected by 42 C.F.R. Part 2, we use and share them only as Part 2 and HIPAA allow. Part 2 protections are stricter than HIPAA. We will not use or share those records, or testimony about what they contain, in any civil, criminal, administrative, or legislative proceeding against you unless you give specific written consent or a court orders it. A court order must come with a subpoena or other legal requirement, and you must be given notice and a chance to be heard.

Information may be shared again. When we share your information as HIPAA allows, the person or organization that receives it may share it again. Once that happens, it may no longer be protected by HIPAA.

New York's stricter rules. New York law gives extra protection to some health information, such as HIV-related information, genetic test results, and certain mental health records. When New York law is stricter than HIPAA, we follow New York law. For example, we will not share HIV-related information without your specific written authorization, except as New York law allows.

Other uses need your written permission. We will not use or share your information in any way not described in this notice unless you give us written permission. If you give us permission, you can take it back in writing at any time. Taking it back won't undo anything we already did with your permission.

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

Changes to the Terms of This Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website at queenscentraldental.com.

Questions and Contact Information

If you have questions about this notice or want to exercise any of your rights, contact our privacy contact:

Dr. Ilya Ames, DDS

• Ames Dental P.C., doing business as Queens Central Dental
• Address: 83-06 Northern Blvd, Jackson Heights, NY 11372
• Phone: (718) 429-0440
• Email: queenscentraldental@gmail.com (please don't email health details; call us instead)

¿Prefiere hablar en español? Llámenos al (718) 429-0440.

This notice is effective as of October 16, 2026.